Workers' Compensation Forms

• Authorization to Invoice MSU - PDF*
• Authorization to Invoice MSU for Employees not in the Lansing Area - PDF* Word
• Report of Claimed Occupational Injury or Illness - PDF* Word
  
  

Seeking Treatment for Exposure to Blood Borne Pathogens

• Exposed Patient Instructions (pdf)
• Exposed Employee Lab Worksheet (pdf)
• Source Patient Lab Worksheet (pdf)

Seeking Treatment for Work-Related Illness or Injury

Employees who suffer a work-related illness/injury should immediately report the injury to the supervisor. The following is the process for seeking medical care.

Supervisors are to immediately call an ambulance (9-1-1) if the illness/injury is a critical emergency. The ambulance driver will transport the individual to the nearest medical facility available for treatment.

When the illness/injury is not critical, the supervisor is to complete the Authorization to Invoice MSU (pdf)* and direct the employee as follows:

Three follow-up visits must be scheduled at Olin Health Center for any of the following:

• hepatitis, AIDS, human blood, or bodily fluids exposure,
• work with a respirator,
• work around or with asbestos,
• work with formaldehyde, ethylene oxide, hazardous waste,
• work with pesticides or other chemicals, and/or
• work with or around animals.

For on-campus work-related injury cases when the illness/injury is not critical and the employee cannot drive him/herself to Olin, the Olin Courtesy Van may be called between 8:00 a.m. and 5:00 p.m. at 517-353-4700. Spartan-Yellow Cab may be called anytime after 5:00 p.m. at 517-482-1444, as well as Big Daddy Taxi at 517-367-7474.

Out-of-town supervisors should send employees with injuries to the nearest medical facility that has the capability of treating the injury. An Authorization to Invoice MSU (pdf)* for employees not in the Lansing area should be completed and sent with the injured individual.

Within 24 hours after a reported illness/injury, the injured worker is to complete the Report of Claimed Occupational Injury or Illness (pdf)* . Copies must be distributed to the parties listed at the bottom of the form. Do not wait for medical reports before filling out this form.

An Occupational Injury Restriction Report, with or without restrictions, must be provided by the employee to his/her immediate supervisor. An employee capable of performing the essential functions of his/her job will be returned to work. An employee requesting reasonable accommodation of his/her position will also be returned to work upon accommodation.

*Adobe Acrobat Reader is required to read PDF documents.